Introduction:

The IMT Stage 2 curriculum, introduced in 2022, emphasised simulation-based education with a focus on human factors to progress at ARCP [1]. Existing simulation for Medical Registrars remains limited and rarely integrates these elements [2,3].

We developed a one-day simulation course for ST4-5 registrars, embedding human factors into each scenario to meet curriculum needs. To enhance realism and observer engagement, we also created a web-based patient record enabling faculty-controlled access to documentation and results.

Methods:

The course, GIM-Sim:3, was piloted in March 2025. Eight scenarios were developed, each with a distinct human factors theme and integrated clinical case, mapped to the IMT Stage 2 curriculum. Clinical topics were selected to differ from earlier courses in the series and aimed to support ARCP requirements for Stage 2. Candidates completed a pre-course questionnaire to identify knowledge or portfolio gaps, enabling pre-allocation of scenarios aligned to their goals.

A “Simulated Electronic Patient Record” (Sim-EPR) was created to enhance the scenario experience and ensure equal access to information for observers. This mobile-optimised web platform provided access to notes, results, and guidelines—controlled by faculty via the interface. Candidates could access results and protocols as in practice, while observers viewed the same information in real-time, and embedded faculty could realistically “look up” information when delegated.

Results:

All candidates found the simulations interesting, with clear and effective delivery. All reported that learning from the day would impact their practice and said they would recommend the course to other trainees.

Participants rated each scenario for clinical relevance and human factors relevance (1: not at all relevant, 5: highly relevant). Every scenario averaged above 4.5 in both areas, with no rating below 4 (Figure 1).

Eighty per cent of candidates felt the electronic patient record enhanced their experience, and none rated it negatively.

Discussion:

Our high-fidelity simulation courses allow candidates to browse notes and guidelines, request tests, and view results. However, observers often struggle when results are visible only to active candidates. We developed the Sim-EPR to enhance fidelity—reflecting the longstanding use of electronic records in the UK—and to give observers access to the same information, improving engagement and learning.

This system was piloted alongside our new high-fidelity human factors course, addressing a key gap in the IMT Stage 2 curriculum. Scenarios were designed primarily around human factors, with clinical cases developed to fit, ensuring full integration and realism within NHS practice.

Ethics Statement:

As the submitting author, I can confirm that all relevant ethical standards of research and dissemination have been met. Additionally, I can confirm that the necessary ethical approval has been obtained, where applicable.

References

1. Joint Royal Colleges of Physicians’ Training Board. Internal Medicine Stage 2 Training Curriculum [Internet]. 2022 [cited 2025 Apr 14]. Available from: https://www.thefederation.uk/sites/default/files/Internal%20Medicine%20(Stage%202)%202022%20curriculum%20FINAL%20200522_0.pdf.

2. Abildgren L, Lebahn-Hadidi M, Mogensen C, et al. The effectiveness of improving healthcare teams’ human factor skills using simulation-based training: a systematic review. Adv Simul. 2022 May 22;7(1):12. doi: 10.1186/s41077-022-00207-2.

3. Tipton A, Chatfield S, Waterhouse E. A100 A novel simulation course for GIM (General Internal Medicine) registrars, which fulfils the new GIM stage 2 curriculum simulation requirements. J Healthc Simul. 2024 Nov;4(Suppl 1). doi: 10.54531/FDRV1134.

Supporting Documents – Figure 1-A54